Humanitarian crises monitoring: impact of coronavirus (interim findings) Contents

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4The UK response

Introduction

68.The coronavirus outbreak was a global emergency by the end of January 2020 and an official pandemic on 11 March. The then International Development Secretary published a call to action on 9 April, jointly with northern European counterparts. This statement of intent hit many of the notes which have since come up in our evidence (and in subsequent action). These include collaboration, non-health impacts, gender issues, the importance of W.H.O; equitable access to vaccines, temporary debt service relief, mobilising the private sector, universal health coverage, a global health strategy and long term thinking.62

69.The next step was a global pledging conference on 4 May.63 In total, $8 billion was pledged. This involved:

• $3 billion will have to be spent to develop, manufacture and distribute a possible vaccine against Covid-19
• $2.25 billion needed to develop treatments for Covid-19
• $750 million for testing kits
• $750 million to stockpile protective equipment
• $1.25 billion for the World Health Organisation to support the most vulnerable countries.

70.The UK’s reported pledging at this conference was not new money but had already been announced (arguably because the UK had acted faster than other donors to identify and commit resources). The Prime Minister was described as confirming UK’s pledge of £388 million in UK aid funding for research into vaccines, tests and treatments–part of a larger £744 million worth of UK aid committed to help ending the pandemic and supporting post-Covid global economic recovery.64

71.The Committee was keen to hear about: governance around the public/private partnerships in receipt of UK aid in this initiative, progress towards effective medicines and the mechanisms for guaranteeing affordable and equitable access to the products in every developing country regardless of countries’, or individuals’, buying power.

CEPI

72.£250 million was allocated to the Coalition for Epidemic Preparedness Innovations (CEPI) to develop vaccines against coronavirus. CEPI is a Norwegian Association, a coalition between public, private, philanthropic and civil society organisations that work in partnership. The pledge consists of £230m from DFID and £20m from the Department of Health and Social Care.

73.The initial tranche (£20) was disbursed in March 2020 and covers the period to 31 May 2020. The balance (£210m) covers the period to 31 March 2021. The funding is allocated by CEPI to organisations identified through the Partnership’s competitive calls for R&D proposals. UK funds will be used primarily to support CEPI’s vaccine work for the benefit of low/middle income countries. Success will be achieved by the development of an effective vaccine for Covid-19 that is accessible and affordable in developing countries. DFID, now the FCDO, will assess the extent to which this work advances the scientific evidence base through its usual monitoring processes including receipt of reports from CEPI and published peer-reviewed research papers etc. DFID wrote that vaccine research was very high risk and there could be no guarantee that UK funding through CEPI would result in a successful vaccine candidate.

74.Dr Samia Saad, Director of resource mobilisation and investor relations at CEPI told us that the reason for CEPI being founded was that, while there were lots of different efforts towards developing vaccines or other health interventions to fight epidemics, et cetera, there was not enough investment in preparedness.65 For example, while there was a vaccine for Ebola, the one that ended up being successful had only gone part of the way through development and had then sat on a shelf. The core of CEPI’s mission is equitable access and leaving nobody behind. Dr Saad told us:

The key for a global pandemic is that you need an efficacious vaccine that is going to give you immunity. We still are learning a lot about the disease because it is so new. … Speed, scale and access are the drivers around the portfolio. … We are hopeful, but again, the science does not always do what you want it to do. We are getting good signals that we might have some doses, not billions, but 100 million doses if we are lucky, at the end of the year.66

75.Dr Saad was clear also that: “In the short term, nobody is going to make any money out of any of these tools, really. In terms of the [intellectual property] and how we manage it, the focus is on equitable access. There are very stringent global access conditions in the contract.”67

CTA

76.£40 million was allocated to the Covid Therapeutics Accelerator (CTA), a collaborative initiative, commencing in March 2020, pooling funding for the rapid development of Covid-19 treatments. in low and middle income countries. The accelerator is supporting the development, and scaling up, of a broad range of treatments for Covid-19. The immediate focus is to develop therapies that can be made available within this year, 2020.

77.DFID has pledged up to £40 million to the initiative for 2020/21, alongside the Bill & Melinda Gates Foundation, Wellcome, Mastercard and other funders. The funding is for channelling through the CTA to organisations successfully awarded resources in accordance with the “The Accelerator’s” processes. Funds will partly be routed through The Wellcome Trust and partly disbursed directly from DFID.

78.The Accelerator will provide funding for groups to research (i.e. conduct clinical trials), develop and bring effective Covid-19 treatments ‘to market’, quickly, for use in low and middle income countries (LMICs). Success will be demonstrated by the development of effective therapeutics that are available, affordable and accessible in LMICs. DFID expected to know about the extent to which this work advanced the scientific evidence base through its usual monitoring processes including receipt of reports, published peer reviewed research papers etc. DFID staff are also on the CTA Steering Committee which meets weekly to review the progress of the research.

79.Dr Josie Golding, Epidemics Lead, Wellcome Trust (part of both CEPI and the Covid Therapeutics Accelerator (CTA) partnership), described the CTA’s purpose as filling a gap: “While there has definitely been a focus on vaccines over the last few years for epidemics, there has been no coordination effort related to therapeutics; so, this is part of what we saw as a big gap, in particular with Covid. Similar to CEPI, the main function is equitable access, particularly in low-resource settings, making sure these treatment options are available.” She emphasised that the CTA was not a new entity but a collaboration of funders—with clear governance arrangements—able to mobilise resources quickly.68

80.Dr Golding told us:

The focus for our funding call was on low and middle-income countries, so our portfolio is around £12 million pounds supporting research carried out on the African continent and in south-east Asia. This research is critical to vaccine development and therapeutics, because it provides the knowledge we need on the risk factors and the immune response against Covid. That sort of research is absolutely essential, so we funded that.69

81.Dr Golding highlighted that the Wellcome Trust had various investments across Asia and the African continent, and over decades had been building up clinical research capacity, particularly the trial capacity. She said that this was why they invested and promoted research in the global south; to make sure research for treatment options could use those clinical trial sites.70

FIND

82.£23 million was allocated to support the Foundation for Innovative New Diagnostics (FIND), to develop rapid tests for the virus to help identify and slow its spread. FIND is a not-for-profit charitable foundation and product development partnership (PDP) based in Geneva. As a PDP, FIND works closely with industry and academic partners to research, develop and support the accessibility of new health technologies for developing countries.

83.FIND’s specific purpose is to drive innovation in the development and delivery of diagnostics to combat major diseases affecting the world’s poorest populations. It is the only organisation of its kind solely focussing on diagnostics and has the technical expertise to address the full diagnostics value chain, from end-to-end, from test developers to end-users.

84.DFID pledged up to £23m to FIND for the financial year ending March 2021. Of this funding £11m will be paid in June, £7m November and £5m March 2021 for COVID activities (this is an assumption based on forecasting as funding is core funding and paid upon funding requests).

85.Funds to FIND will be used for the evaluation of new diagnostics, and quality assurance of new tests; capacity-building for Global South partners in laboratory work; piloting a rapidly deployable, mobile laboratory for diagnostics for new outbreaks; support for manufacturing to produce high quality rapid diagnostics tests; market access for LMICs to access diagnostics; and driving further innovation and building of LMIC diagnostic capacity using digital tools.

86.Success will be seen in the development and availability of new diagnostics tests in LMICs. DFID monitored Find via formal and detailed annual reports from the partnership and, in addition, the Department remained in close contact with FIND programme staff. Professor David Heymann CBE, LSHTM and FIND board member, told us that, since establishment in 2003, FIND, had been integral in the development of 24 new diagnostic tools, in turn these had been effective in providing tests to 150 lower and middle-income countries. He added that, while there had not yet been a major breakthrough in vaccines or in therapeutics, there had been a diagnostic test that was useful, not only in identifying people who are sick, but in outbreak containment activities, identifying contacts who are sick and who need to be isolated as well.71

87.Dr Heymann emphasised that the whole context of FIND was to work towards tests that were effective in developing countries and can be made available. To operationalise this, FIND had invested quite heavily in a project in Senegal, which would be a transfer of technology—the development of diagnostic tests from Mologic (a UK manufacturer)—to Senegal. There will be development and production of tests, which will then be provided to countries throughout Africa at a fair price within Africa.72

88.DFID also provided £75m for the World Health Organization’s critical health systems response and said that that the UK had also pledged the equivalent of £330 million per year over the next five years to Gavi, the Vaccine Alliance.

89.DFID also emphasised that it was:

• working with businesses, such as Unilever, to tackle the virus allocating £50 million to raise awareness of the importance of hygiene and distribute hygiene products
• allocating £130 million for UN agencies (£65 million to the World Health Organization which is coordinating international efforts to slow infections)
• providing £50 million specifically for the Red Cross in difficult to reach areas such as those suffering from armed conflict
• allocating £20 million for NGOs to help prevent the virus from spreading in the poorest countries through strengthening health systems and providing essential supplies
• providing £150 million for the International Monetary Fund’s (IMF) Catastrophe Containment Relief Trust (CCRT) to help developing countries meet their debt repayments so that they can focus their available resources on tackling Covid-19
• working closely with other G20 creditors and the Paris Club to provide a temporary suspension of debt repayments from the poorest and most vulnerable countries that request relief to assist those countries’ capacity to respond to the crisis
• undertaking long term work, as the largest government donor, with Education Cannot Wait (education provision in crises) which is supporting children in 16 Covid-19 hit countries through $15 million of emergency grants, and
• providing support that has been challenging harmful misinformation about Covid-19 in South East Asia and Africa before it can be spread worldwide and harm the initiative

90.DFID also reported that existing bilateral programmes are being adapted to support communities affected by Covid-19 in partner countries. For example, in South Sudan, including support for infection prevention and control as well as water, sanitation and hygiene activities; and in Bangladesh, providing a package of assistance which included help to maintain essential humanitarian services and support Rohingya and host communities for Covid-19 preparedness in the Cox’s Bazar refugee camps.73

Next steps

91.On the specific next steps, we believe the FCDO should:

• recognise that the eradication of the pandemic everywhere is an integral part of resolving the threat anywhere and therefore switch its financial support for Covid-19 vaccines, therapies and tests voluntarily from its ODA pot to other budgets (thereby freeing up resources for more frontline activity on secondary impacts in developing countries)
• re-commit to its ongoing programmes and provide new funding for the Covid-19 response—in particular in relation to secondary impacts—from ODA, freed up from Covid-19 vaccine R&D, rather than allowing the transfer of scarce resources from existing programmes, especially those tackling other diseases
• use its significant leverage as leading development actor in many areas (gender equality, disability inclusion, poverty alleviation) to lead an inclusive and transparent approach by the donor community (both bilateral and multilateral),
• put local non-governmental organisations (NGOs) and their partner International NGOs at the heart of the global Covid-19 response as they are closest to end-user communities and benefit from existing relationships of trust and confidence.

Official Development Assistance

92.We were interested in whether Covid-19 vaccine, etc., R&D was ODA eligible. According to the OCED’s Development Assistance Committee (DAC), its statistical working party (WP-STAT) met in June to discuss this and other matters around the ODA eligibility of COVID-19 related activities. The OECD Secretariat presented a ‘Frequently Asked Questions (FAQs)’ document, setting out its interpretation of ODA-eligibility based on the DAC Reporting Directives.

93.During the WP-Stat meeting, not all members agreed with the Secretariat’s interpretation of the rules in this instance. In particular, two members disagreed with the assessment of the eligibility of research for a Covid-19 vaccine. Several members expressed a preference for a case-by-case approach to assessing ODA eligibility, rather than blanket exclusions.

94.Following the meeting, the FAQs document was posted on the OECD website. The FAQs document is glossed by a note that makes clear that the guidance is preliminary, and will be updated as discussions among DAC members evolve and concrete examples of activities have been assessed for eligibility by the OECD Secretariat. At the relevant point, the FAQ document asks:

FAQ3. Does research for developing a vaccine/tests/treatments for COVID-19 count as ODA?

And the answer given is:

For research, specific eligibility rules apply [see paragraph 101 in the Reporting Directives, DCD/DAC/STAT(2018)9/FINAL]:

Research into the problems of developing countries is ODA-eligible, conducted whether in the donor country or elsewhere. To be eligible, research needs to be either:

(i) undertaken by an agency or institution whose main purpose is to promote the economic growth or welfare of developing countries,

(ii) commissioned or approved, and financed or part-financed, by an official body from a general purpose institution with the specific aim of promoting the economic growth or welfare of developing countries.

According to the rules, the focus is on problems of developing countries. This ruling has led to the exclusion from ODA of research that benefits developed countries as much as developing countries: ODA includes medical research only in relation to diseases that disproportionately affect people in developing countries.

For example, medical research on cancer is excluded from ODA unless it focusses on cancers with a high burden on developing countries

Similarly, research for a vaccine/tests/treatments for COVID-19 would not count as ODA, as it contributes to addressing a global challenge and not a disease disproportionately affecting people in developing countries. This situation may evolve. If research in the future looked into the development of a COVID-19 vaccine specifically for developing countries, it would count as ODA.

Several initiatives are being launched at the moment to collect funds for COVID-19 vaccine research or to facilitate global access to vaccines. They will be reviewed on a case-by-case basis by the Secretariat, as part of the regular WP-STAT and ODA reporting processes, and all elements of their design and objectives will be taken into consideration when assessing their eligibility.74

95.In a supplementary submission, the Government said, of all funding allocated to coronavirus medicines research and development, that: “Our assessment of this expenditure, and the vital work it supports, is that it meets the definition of Official Development Assistance.”75 The ODA eligibility of COVID-related activities will be discussed again at the next meeting of WP-STAT in November.

96.We conclude that, for the time being, it would not be prudent for the Government to work on the basis that funding allocated to research for vaccines, treatments or tests for Covid-19 would count as ODA, as it “contributes to addressing a global challenge and not a disease disproportionately affecting people in developing countries”. Our view is that this frees up a substantial sum from the 2020 ODA pot to be applied to, either alleviate part of the cuts made in anticipation of reduced GNI for 2020, or activity aimed at alleviating secondary impacts of the Covid-19 pandemic. We would recommend the latter course (in so far as the options are mutually exclusive).